Role of synovial biopsy in diagnosis of chronic periprosthetic infection in total hip and knee arthroplasties.

Abstract

Introduction: Infection is a significant and challenging complication of total hip and knee arthroplasties. Diagnosing chronic periprosthetic joint infection (PJI) can be difficult, particularly when joint aspiration yields inconclusive results or no intra-articular effusion is available for aspiration. Synovial biopsy represents a potential diagnostic option. This study evaluated the reliability of minimally invasive surgical biopsy for diagnosing chronic PJI.

Materials and methods: This retrospective, single-centre, observational study was conducted over a 10-year period. It included consecutive patients who underwent synovial biopsy in the operating room for suspected chronic PJI following failed joint aspiration. All patients subsequently underwent prosthetic revision surgery, and the final diagnosis of infection was determined based on the 2018 International Consensus Meeting criteria.

Results: In total, 52 patients were included, with 20 confirmed cases of PJI. Biopsy cultures were positive in 11 patients. The diagnostic accuracy of minimally invasive biopsy was 78.8%, with a sensitivity of 50%, specificity of 96.9%, positive predictive value of 90.9%, and negative predictive value of 75.6%. Bacteriological concordance between biopsy findings and revision-surgery samples was observed in 70% of the cases.

Conclusion: Minimally invasive synovial biopsy demonstrated limited diagnostic performance for chronic PJI, and should not be performed routinely.

Level of evidence: IV; retrospective study.